個別醫師總額對醫療行為之影響

Effects of Doctor’s Individual Global Budget on Physicians’ Practice

張維淳(Wei-Chun Chang)

指導教授 ： 林耀欽

元智大學/資訊學院/資訊管理學系/碩士(2006年)

摘要

本研究之個案醫院於民國九十四年因參與所在之健保分局實施的個別醫院總額制度(分級管理)，為有效的管控醫院的健保費用於規定的額度內，故仿照健保局分配額度的方式，針對個案醫院院內所有資深主治醫師、主治醫師進行健保費用總額度的分配。本研究想探討在個案醫院實施個別醫師總額制度下，醫師是否僅顧及本身的利益，不斷的增加服務量及醫療資源耗用，不理睬醫院的整體政策？或是考量醫療資源有限，減少輕症病患的服務量？是否對疾病較嚴重的病患產生影響？
本研究以代表輕症的”上呼吸道感染”及代表重症的”腫瘤 ”兩種嚴重度不同之疾病分別探討，醫療行為以就診人次、平均每人次醫療費用、平均每人次藥費、平均每人次開藥天數、平均每人次診療費用五個指標來衡量。九十三年一月~七月費用為個別醫師總額制度實施前的資料是對照組，九十四年一月~七月費用為個別醫師總額制度實施後的資料是實驗組，醫師的職級及專科別亦在本研究中分別探討之。
本研究資料來源為，個案醫院93年1月—7月及94年1月-7月健保申報資料檔案轉錄為EXCEL檔案，整理再以SPSS10.0進行統計分析。
不管是”上呼吸道感染”或”腫瘤 ”，個別醫師總額制度的實施後，醫師服務量無明顯下降。”上呼吸道感染”每人次醫療費用、藥費、給藥天數、診療費於個別醫師總額制度的實施後均明顯下降，且達統計上顯著意義。醫師透過減少每一人次用藥、檢查、處置的方法，達到管控費用的目的。”腫瘤 ” 每人次醫療費用、藥費、給藥天數、診療費於個別醫師總額制度的實施後沒有太多的變化，因此個別醫師總額制度的實施，對於重症的病患就醫權益並無影響。疾病嚴重度、醫師職級、醫師科別都會影響醫師的醫療行為。
建議主管機關及醫院管理者，進行總額的分配時，需考量收治之疾病嚴重度，醫院若需實施個別醫師總額制度，建議採取漸進方式管控醫師之醫療費用，最後再採取與醫師獎金連動方式，另醫師獎金連動制度之訂定需考量收治病患之疾病嚴重度。

關鍵字

個別醫師總額 ； 醫療行為

並列摘要

In the year of 2005 ,this study’s case hospital participated hospital global budget , the strategy of NHI Research .For the effective management, case hospital divided fee between senior physician and physician. This research wants to probe into under the circumstances that the case hospital implement the doctor’s individual global budget, the doctor take one's own interests into account only, the constant serving amount of increase and medical resource are consumed, ignore the whole policy of the hospital? Or it is limited to consider medical resources, reduce the light disease patient's service amount? Does the patient more serious to the disease exert an influence?
This study use " influenza " to represent light disease,and " tumour " to represent serious disease. And we use “the number of patients” ,” average every person hospitalization cost”, “every person expenses for medicine on average”, “every person write a prescription day on average”, “every person expenses for treatment on average”,this 5 indicator to find out the difference between the implement of the doctor’s individual global budget. The contrast group were in the year of 2004, experiment groups were in the year of 2005 after being implemented of the doctor’s individual global budget. Length of service and training of doctor also probe among this research.
This research materials source is from the case hospital file , that for NHI.The file record to EXCEL file and put in order to carry on statistical analysis with SPSS10.0.
No matter " influenza " or " tumour ", after implementation of the doctor’s individual global budget , doctor's serving amount has not obviously dropped. " influenza " every person hospitalization cost, expenses for medicine, give medicine day, treatment fee obviously drop after the implementation of the doctor’s individual global budget. The doctor, through reducing the method that every person uses medicine, checking, handling, achieve the goal of in charge of accusing of the expensesing. " Tumour " every person hospitalization cost, expenses for medicine, give medicine day, treatment fee have not too many changes after implementation of the doctor’s individual global budget, so the implementation of the doctor’s individual global budget, had no influence of the serious patients' rights and interests. Disease serious degree, doctor length of service, doctor department can influence medical behavior of doctor.
Propose the competent authority and hospital administrator, while carrying on the distribution of global budget , need to consider the serious degree of disease accepted for medical treatment, if hospital need to pratice the doctor’s individual global budget, propose advance gradually way . Finally , use the doctors’ bonus and consider the degree of disease.

並列關鍵字

Doctor's Individual Global Budget ； Physicians' Practice

參考文獻

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